Fertility problems affect approximately one in seven couples in the United Kingdom (UK) [
1]. In women, infertility may be due to ovulatory problems, anatomical disorders such as damaged fallopian tubes and/or endometriosis [
2]. Causes of male infertility include; abnormal semen characteristics, impaired reproductive tract, erectile dysfunction and/or ejaculatory disorders [
3]. Following investigations and treatment for any aetiological factors, couples may seek assisted reproductive technology [
2,
3]. In 2010, 27,918 couples underwent fertility treatment in the UK [
4]. Unfortunately, the success rate of in vitro fertilisation (IVF) using a female’s own fresh eggs is low at approximately 25% [
5], and the process of IVF is not without its own physical and emotional challenges [
6].
One of the causes of damage to both female and male reproductive systems is a delayed or untreated sexually transmitted infection (STI). The most common STIs to cause female and male infertility are chlamydia and gonorrhoea. Chlamydia is the most frequently diagnosed STI in England with 186,196 new cases diagnosed in 2011, with young people (aged 15–24 years) being at most risk [
7]. Being a largely symptomless disease, it can often go undiagnosed and, therefore, untreated. Persistent chlamydia infection can potentially cause serious complications for both men and women [
8]. If left untreated, women are at risk of developing pelvic inflammatory disease (PID). This is a serious condition involving inflammation of the upper female genital tract and supporting structures. It causes various complications including chronic pelvic pain, increased risk of ectopic pregnancy and tubal factor infertility (TFI) [
8], which is a significant cause of infertility [
9]. Of the 14,551 reasons for requiring IVF treatment given in 2010, the majority of these (other than unexplained) were for tubal factors [
4]. In women, the link between infertility and past infection with chlamydia has previously been well-documented [
10‐
14] although a more recent systematic review containing one RCT has weakened this evidence [
15]. Screening programmes within England (e.g. The National Chlamydia Screening Programme) currently advise young women that chlamydia may cause infertility. The extent to which chlamydia infection impacts on male fertility is still uncertain. Chlamydia can cause inflammation of the epididymis, testes and accessory glands which can ultimately damage sperm [
16]. In men, fertility problems are usually the result of reduced semen characteristics (e.g. low numbers or poor quality of sperm). Although less common than chlamydia in England, there was a 25% increase in gonorrhoea cases from 16,835 in 2010 to 20,965 in 2011 [
7]. Gonorrhoea is similar to chlamydia in its transmission, diagnosis and complications [
17,
18].
Understanding young people’s knowledge and beliefs about the possible long-term consequences of delayed or untreated STIs is important to guide effective sexual health education. Previous research has indicated that 70% of young people feel protecting their fertility is important to them with females reporting greater concern than males [
19]. With regard to young people’s knowledge and beliefs about reproductive technologies for infertility or sub-fertility, research is considerably lacking.
Aims and objectives
Untreated chlamydia and gonorrhoea can have serious consequences in later life, particularly with regard to fertility. There is currently only limited available research regarding the key at risk age groups’ (16–24 year olds) knowledge and beliefs about the link between untreated STIs and infertility, and whether awareness of future fertility issues is of relevance amongst this age group. This study poses the following research questions: What do young people understand, and what are their beliefs, about the link between untreated STIs in particular chlamydia and gonorrhoea, and infertility in later life? Do young people consider discussions about the possible long term consequences of STIs in terms of future fertility relevant at their age?